Medical Education Departments: a Study of Four Medical Schools in Sub-Saharan Africa Elsie Kiguli-Malwadde1,Zohraym.Talib2, Hannah Wohltjen2, Susan C

Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 DOI 10.1186/s12909-015-0398-y

RESEARCH ARTICLE Open Access Medical education departments: a study of four medical schools in Sub-Saharan Africa Elsie Kiguli-Malwadde1,ZohrayM.Talib2, Hannah Wohltjen2, Susan C. Connors3, Jonathan Gandari4, Sekelani S. Banda5, Lauren A. Maggio6 and Susan C. van Schalkwyk7*

Abstract Background: Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability. Methods: In-depth interviews were conducted with the heads or directors of the four medical education departments using a structured interview protocol developed by the study group. An inductive approach to analysis of the interview transcripts was adopted as the texts were subjected to thematic content analysis. Results: Medical education departments, also known as units or centers, were established for a range of reasons including: to support curriculum review, to provide faculty development in Health Professions Education, and to improve scholarship in learning and teaching. The reporting structures of these departments differ in terms of composition and staff numbers. Though the functions of departments do vary, all focus on improving the quality of health professions education. External and internal funding, where available, as well as educational innovations were key enablers for these departments. Challenges included establishing and maintaining the legitimacy of the department, staffing the departments with qualified individuals, and navigating dependence on external funding. All departments seek to expand the scope of their services by offering higher degrees in HPE, providing assistance to other universities in this domain, and developing and maintaining a medical education research agenda. Conclusions: The establishment of medical education departments in Sub-Saharan Africa is a strategy medical schools can employ to improve the quality of health professions education. The creation of communities of practice such as has been done by the MEPI project is a good way to expand the network of medical education departments in the region enabling the sharing of lessons learned across the continent.

Background (HPE) more broadly [2]. Yet, improving HPE is essential Sub-Saharan Africa (SSA) suffers a disproportionate to the development of a robust workforce [3]. share of the world’s burden of disease while also experi- The demand for more physicians globally, coupled encing a significant health care workforce shortage [1]. with the need for high quality education, has led to the In addition, the dearth of medical schools in the region proliferation of medical education departments across threatens efforts to scale up and improve the quality of the world [4]. These departments (also called medical medical education and health professions education education research departments or centers) have many roles, including supporting medical education research, teaching, program evaluation, and facilitating the use of * Correspondence: [email protected] educational technologies [5], and may also impact at 7 Centre for Health Professions Education, Faculty of Medicine and Health multiple levels (undergraduate, postgraduate, and con- Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa Full list of author information is available at the end of the article tinuing medical education) [4].

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Medical education departments first appeared in Europe, within the MEPI Medical Education Research Technical but have since spread to programs in countries all over the Working Group and included (in chronological order of world [6–12]. In general, there are few publications de- the establishment of their medical education departments): scribing the role and development of these departments, and those available are often limited to descriptions of 1. School of Medicine, University of Zambia, Zambia departments in non-African countries with one exception (UNZA) as described by Ofoegbu and Ozumba at the University of 2. Faculty of Medicine and Health Sciences, Enugu in Nigeria [13]. Given the intensifying demands on Stellenbosch University, South Africa (SU) African medical schools to meet health workforce needs, 3. College of Medicine, University of Ibadan, Nigeria (UI) more information is needed about such departments in the 4. College of Health Sciences, University of Zimbabwe, African context. Zimbabwe (UZCHS) The history of medical education in Africa is, however, fairly recent [14]. Few African medical schools were When this study was conducted in 2012, these four established before 1960 and, while some were founded institutions had departments that were either already during the independence decades (1960–79), little growth established or were in development and their directors occurred during the 1980s. Since then, the number of could therefore offer both historical and current per- medical schools in Africa has increased significantly. By spectives on their departments. 2010, 166 medical schools existed in Africa with some Initially, a questionnaire was designed to collect data reporting the presence of medical education depart- from the four sites, however, the development of appro- ments [3, 14, 15]. Many African countries are investing priate questions became too complex to adequately cap- in medical education as a key intervention to improve ture the specific context of each institution. Therefore, health care. the authors, all allied to the MEPI project, chose to In 2010, the United States government launched the conduct a qualitative study using structured interviews Medical Education Partnership Initiative (MEPI - http:// to better understand the nuances and examples peculiar www.mepinetwork.org/). This program provides financial to each site. The interview protocol was developed by support to 13 SSA medical schools over a five-year period the author team, and included a structured design to to boost health worker education and strengthen national provide consistency as different members of the team health systems [1]. The Initiative’s main objectives are to conducted the interviews across the sites (Appendix A). develop capacity in medical schools, retain the workforce, The protocol reflected the evolution from questionnaire and build research capacity. MEPI schools were required to interview format, and although there were relatively to develop and implement medical education interven- few open-ended questions posed, the interviewers were tions and evaluate their effectiveness. Nine of the 13 MEPI encouraged to probe to elicit further details. The tran- schools chose to establish or strengthen medical education scriptions of the interviews provided much richer re- departments to support these efforts. Over the course sponses than could have been obtained with using a of the Initiative, it has become apparent that sound and questionnaire-type format. The principal investigator on well-functioning medical education departments have each school’s MEPI grant was asked to identify the the potential to provide critical support to institutions appropriate interviewees. All interviewees (n = 4) held and health professionals in their medical education positions as the directors or heads of the medical educa- endeavors, as well as enhance medical education research tion departments at the selected sites. Ethical approval that can further support MEPI and related initiatives. This was obtained from the participating institutions as re- paper provides an overview of four medical education quired (for example: SU: N13/07/113). Interviewees were departments. It also describes specific enablers and asked to complete a consent form and informed that constraints that accompany both the establishment and their participation was voluntary. sustainability of such departments with a view to All interviews were recorded and transcribed, and varied informing medical schools in Africa and other under- in length from one hour to 90 min. The data were sub- resourced contexts, that wish to establish or strengthen jected to thematic content analysis [16] by one member of a department of medical education. Table 1 provides the the study (SCvS) who developed a code list using Atlas ti background of the four schools in this study. while a second (ZMT) developed a second code list through manual analysis. These two members compared Methods their initial analyses, finalized the codes, and then com- This article explores the current status of the four pleted the process of categorization. Team members who medical education departments and offers a historical had conducted the interviews verified the outcome. perspective of their development. The case examples Although only four interviews were conducted, the were selected based on the schools’ active participation authors believe that this study generates sufficient data Kiguli-Malwadde ta.BCMdclEducation Medical BMC al. et

Table 1 Overview of the four medical education departments in this study School/college/Faculty name 1 2 3 4

School of Medicine, Faculty of Medicine and Health College of Medicine, College of Health Sciences, (2015) 15:109 University of Zambia, Sciences, Stellenbosch University, University of Ibadan, University of Zimbabwe, Zambia South Africa Nigeria Zimbabwe University established 1966 1866 1948 1952 First medical student intake 1968 1956 1954 1963 HPE programs offered Nursing, Pharmacy, Biomedical Sciences, Physiotherapy, Occupational Therapy, Dentistry, Nursing, Physiotherapy & Nursing, Dentistry, Pharmacy, Environmental Health & Physiotherapy. Dietetics, Speech-Language & Hearing Human Nutrition and Dietetics. Public Health, Radiography, Therapy. Medical Laboratory Science & Rehabilitation Science. ME or HPE department established 2000 2006 2012 2014 Reason for establishing ME or HPE Following the merger of two Location away from main campus To induct and train new staff To support ongoing curricular reforms department complimentary teaching support units which had a functional unit. Growing need to support teaching and learning Person in charge Head Director Head Director Reporting structure Dean Dean Provost Dean Staff structure (including directors) 7 academics 6 academics 4 academics 3 academics 1 administrator 4 administrators 2 administrators 3 administrators ae3o 9 of 3 Page Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 Page 4 of 9

to provide a picture of the status of medical education departments. All departments are positioned within a departments situated in medical schools in Africa. The medical school and ultimately report to a dean or head intention was to not to evaluate, but to identify the en- of the school. Staff numbers and appointments differ ablers and constraints that are experienced in these con- considerably across the departments (Table 1). The more texts in the hope that this might provide insight for established departments have a cadre of academic and others on the continent. non-academic staff, working either full or part-time. Across the institutions, the academic staff have a variety Results of academic backgrounds, including PhDs in HPE or Interviews conducted with lead faculty from the four Education, experience as clinician educators, and other medical education departments provide insight into the educational qualifications. It is, however, important to establishment and development, their mission as well as note that often many of the staff members have been challenges they faced. employed with external funding. Given the small staff complements, reporting structures are horizontal with Motivators for the establishment of medical education academic staff often being responsible for a particular departments role. For example, at Stellenbosch, staff responsibilities The motivation to establish each of the four depart- include ‘student support,’‘faculty development,’ and ments was quite different. At the University of Zambia, ‘medical education research’. the Medical Education Department was created in 2000 (making it the oldest of the four studied) as an efficient The mission and activities of medical education solution to replace two complementary teaching depart- departments ments (the Medical Illustration Department and the All four schools use their departments to build capacity Teaching Development Department). The lead for the for their faculty in HPE, to foster scholarship in teaching Department developed a concept paper, enlisted support and learning, and to support the process of curriculum from senior medical school leadership, and then secured review and renewal. Interviewees described the over- external funding for advanced training in medical educa- arching role of the department as enhancing student tion. The Department was then formed and staffed with learning and improving faculty skills as medical educa- doctoral students interested in medical education. At tors. As one interviewee stated, “The mission of HPE is Stellenbosch University, the motivation was different. to promote professionalism and excellence in health pro- The main University campus had a well-functioning fessions education”. The departments are driven by a de- teaching and learning unit, but the medical school was sire to promote social accountability (i.e. placing priority located on a different campus. The growing need for on the health needs of citizens and societies) and intro- support in teaching and learning served as a catalyst for duce innovative teaching strategies such as community- medical school faculty to start their own department. At based education, problem-based learning, workplace- the University of Zimbabwe, the establishment of the de- based learning and inter-professional education. To partment was driven by a need to provide institutional achieve these aims, the departments offered a wide range support to ongoing curriculum reform. In Nigeria, the of activities (Table 2). University of Ibadan first established their medical education department in 2012 to induct and train new faculty. In all cases, the director or head was the catalyst Challenges to establishing medical education for the departments serving as a champion for educa- departments tion, and these individuals’ efforts were supported by the Interviewees reported that establishing a medical educa- availability of funding and the prevailing momentum for tion department presented numerous challenges. One of innovation in medical education. Interviewees described the main issues identified was establishing and maintain- the process as lengthy and complex, noting that estab- ing the legitimacy of the department within faculty and lishment was often preceded by a period of negotiation university leadership. As a discipline, medical education and planning. was reported to be philosophically different from other medical school disciplines. While most medical disci- Setting up a medical education department – leadership plines draw on a biomedical science model and predom- and staffing inantly engage with research in a positivist paradigm, The medical education departments at the four schools education draws its philosophical roots from psychology have different names (three called Departments, and one and sociology. Medical education, therefore, requires called a Center), often reflecting the position of the de- working across disciplines both within and outside partment in the institution [4, 15]. In all cases, a single health. One respondent, in describing this tension and person serves as a director or a coordinator for the also emphasized the importance of engaging in activities Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 Page 5 of 9

Table 2 Summary of the activities of the four medical education departments canvassed in this study Function / activity Departments 1234 Build capacity for faculty in HPE x x x x Support the development of scholarship in teaching and learning x x x x Support curriculum development, renewal and implementation x x x x Offer Postgraduate diplomas, Masters and Doctorate degrees in HPE x x x Student academic support x x x Mentor faculty and provide educational advice x x Provide quality assurance at the institution and affiliated schools x x Consult on education matters for the region x Coordinate research in medical education x x Manage the clinical skills laboratory x x such as international collaboration to enhance faculty at risk. Funding was required for physical infrastructure and leadership perceptions of the department: (such as office space, equipment, and telephones) as well as personnel. Department staff members are often The biggest challenge was that at inception the appointed with ‘soft’ funding from grants and other out- concept of medical education was new to most side sources. Despite the challenges of working with grant members of staff who had a good 20–25 years funding, there was acknowledgement of the value of [experience] and had not heard about the medical external funding as it stimulated interest, activity, and sup- education services the department is providing. As a port for the department both from within and outside of result, [there was] suspicion and resistance and the institution. In this regard, the impact of MEPI was uncertainty to where it was going but with more specifically noted as essential to the establishment and exposure to international communities and training in maintenance of the departments, especially at Ibadan and other universities, the acceptance uptake has been Zimbabwe. Some departments were able to expand their very high because they have seen that this is activities through MEPI funding, particularly in the areas happening elsewhere. of e-learning and medical education research. One interviewee described how the MEPI goals shaped the develop- In addition to establishing the credibility of the department of the medical education department: ment, interviewees described a number of other challenges in running their departments including transient funding We are going to work with the MEPI group so that sources, the need to manage faculty expectations, and we develop the department in line with the demands setting realistic goals while working towards an ambitious of MEPI which are: capacity-building, improving qual- vision. Funding streams tend to be grant-based rather than ity of medical education, retention and introduction institutional, placing the sustainability of the department of new methods of applying knowledge.

Table 3 Challenges and perceived enabling factors as reported by the four medical education departments in this study Challenges Enabling factors Establishing and maintaining the legitimacy of the department Ensure academic status for the department within faculty and university leadership Align with the school and institutional strategic foci Seek legitimacy for the department – acknowledged stature among faculty and within the school Securing and retaining appropriate staff Secure active and sustained support at senior level Hire staff who have expertise or qualifications in HPE Employ a qualified leader as champion Sustaining the department in terms of funding Build on the current regional call for medical education innovation Obtain funding from the institution and external grants Develop internal income-generating activities (e.g., postgraduate HPE programs which charge tuition) Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 Page 6 of 9

Key enablers in establishing a medical education and short case for our clinical courses was department championed by the [department], for introduction of The challenges of establishing and maintaining medical more objective and more varied assessment methods, education departments were mitigated through various including the objective strategy for clinical medical strategies including engaging leadership and building key education. The drive to try and get the school do a relationships (Table 3). The University of Zambia inter- self-evaluation against the World Federation of viewee indicated that support from management was Medical Education standards was driven by [medical important because it facilitated “[jumping] through the education department staff]. Also, the initiative to do different [bureaucratic] hoops”. Engaging faculty from a comprehensive curriculum review in the School of different disciplines and from different departments was Medicine to begin to bring awareness of innovative also seen as an enabler and critical to earning the sort of educational methods and to change the curriculum credibility that was described earlier. The interviewee from a totally traditional curriculum to start moving from Stellenbosch reported that, because the work and towards some innovative strategies was driven by research of the Center crossed disciplinary boundaries, [departmental staff]. So with regard to being a change the department had high visibility within the school. At agent, I think [medical education departments] plays a the University of Zambia, the staff members from the very key role. medical education department collaborate with the library to support faculty in transferring lecture material The future and sustainability of medical education to the e-learning platform. Exposing faculty to the departments discourse of medical education globally was seen as All interviewees had clear objectives for the future of their crucial to informing the work of the department and departments and reported seeing medical education as an raising the standards of teaching and learning, specific- area destined for expansion and increasing legitimacy. One ally with regard to curriculum reform. Adequate funding interviewee at the University of Zambia viewed the work for the department was also critically linked to recruiting being done currently as a “pipeline issue” that would bear and retaining academic staff members who can provide fruit in years to come. Developing and maintaining a leadership for teaching faculty. Having a qualification in medical education research agenda was a priority for all in- HPE or exposure to other advanced training in educa- terviewees. Having a research output was considered crit- tion was seen as necessary for both the leads and the ical to maintaining the credibility and significance of the staff of a medical education department. One inter- department as well as achieving international visibility. The viewee explained, “I think it is an advantage, definitely interviewee from Stellenbosch University felt it was im- an advantage to have someone with preferably a formal portant for the department to have a well-defined research qualification in teaching”. focus and to identify faculty who would conduct research in this area. Collaboration around capacity-building initia- Measures of success tives, conferences, and more medical education journals Interviewees pointed to a number of measures of success. for Sub-Saharan Africa, were also seen as desirable goals. Departments at the Universities of Stellenbosch, Ibadan, All interviewees articulated a need for developing fu- and Zimbabwe have evolved to become recognized aca- ture staff, particularly staff focused on medical education demic departments and thus established entities in their scholarship (e.g. PhD and Masters graduates). They also institutions. Other successes include the growth in HPE planned to continue capacity-building by offering work- postgraduate offerings, increased graduates from HPE shops to provide advanced training in innovative teach- programs, increased numbers of grants secured that can ing methods as well as mentoring for faculty members support the work in medical education departments, and interested to pursue careers in medical education. The the provision of support to other institutions on matters interviewee from the University of Ibadan reported plans relating to medical education activities. Building up cap- to advocate for recognition of teaching excellence as a acity to offer postgraduate degrees in HPE was cited as an criterion for promotion, while the interviewee from important indicator of success. Zimbabwe shared the hope of establishing a College of The interviewee from the University of Zambia further Health Professions Education to provide comprehensive explained the impact of the medical education depart- postgraduate training. Finally, interviewees intended to ment in terms of its potential to act as a change agent: ensure legitimacy of their respective departments by conducting rigorous evaluation of their activities. With regard to education innovation, we know that [medical education department] has been a prime Discussion player. For instance, the adoption of changing The establishment of medical education departments examination systems from the traditional long case that focus on enhancing the quality of physician training Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 Page 7 of 9

is a valuable initiative to support Africa’s health work- acknowledged the importance of having faculty leaders force needs [9, 10, 15]. MEPI has catalyzed widespread with advanced training in HPE. Similarly, experienced investment in medical education, and there has been a medical educators or clinicians played critical roles in growth of medical education departments as schools building these departments, further validating the need seek to sustain and support these new educational for well-trained and motivated champions. These HPE activities. The availability of MEPI funding has stimu- experts serve an important advocacy role with the lated both the creation and strengthening of medical potential to create higher standards for medical educa- schools’ infrastructure to support faculty development tion in the region, stimulate medical education research, and scholarship in medical education and the role and enhance the discipline’s standing. Fostering leaders played by these medical education departments is evi- in HPE who feel empowered as a result of being part of dent from this research. At the four schools included in the community of practice provided by the medical this study, the role of the departments are similar and education departments is critical in this context [19]. arealignedwiththeMEPIgoalsofimprovingthequal- As has been reported in other developing countries ity and quantity of medical graduates and increasing [9], major challenges to the four African departments capacity for research. They are also aligned with the included in this study were limited infrastructure, fund- Association for Medical Education in Europe’scharge ing, and faculty understanding. Leaders addressed these to focus on research, faculty development in HPE, and challenges by linking with senior management, estab- support for learning and teaching [4, 17]. lishing formal structures with their schools, and lever- Although the four departments are at different stages of aging external funding to develop income-generating their development, they share common lessons learned in activities. These early findings from medical education developing their respective departments. These include departments in Africa suggest their sustainability will the importance of starting small, establishing relationships rely on the motivation of the medical education department with key stakeholders in the institution, and developing leaders, support from university leadership, a sustained credibility among colleagues and leadership. Ultimately, drive for curricular improvements, and creative funding one of the indicators of success that will contribute to the sources. value and sustainability of these departments is their The findings of this study should, however, be consid- ability to engage in medical education research. An ered in light of the following limitations. All members of aspiration of one of departments is to enhance the the study team were involved in the MEPI in various recognition of educational scholarship as a criterion for roles and, therefore, have an interest in supporting the promotion. Such recognition has not been considered at success of medical education in Sub-Saharan Africa. many universities in the developing world in the past Although this vested interest may have potentially biased [18] and could serve as an important catalyst to further the study team, all members were reflexive in their stance scholarlyworkinthefield. and approached the project as researchers focused on the As medical schools grow in Africa, the need for research question. In addition, we recognize that our in- global and regional engagement becomes more appar- terviewees would have been predisposed to presenting ent. Therefore, fostering a community of practice is a their centers in a positive light. Nevertheless, we believe key strategy in developing the field of medical educa- that the study provided an opportunity to reflect on the tion and supporting the necessary related institutional current status of medical education departments on the structures [19]. The MEPI network of schools has continent and that interviewees participated with this established a Technical Working Group on Medical objective in mind. Lastly, institutions were selected based Education Research, which provides a platform for SSA on their active participation within the MEPI Medical schools to network, share ideas, and engage in medical Education Research Technical Working Group. Future education initiatives. Activities that support and nur- research might consider extending its reach to provide a ture this community of practice will be critical to facili- broader spectrum of accounts. tate the sharing of resources and lessons learned. Identifying best practices globally and in the region will Conclusions enable their efficient and successful replication. Medical The establishment of medical education departments in education staff and leaders are often pioneers in their in- SSA has taken root. Though relatively new in these four stitutions seeking to establish a new field of study. Joining schools, the departments are already established in their regional or global communities with similar interests and respective institutions through the efforts of medical challenges can fill the void while local communities and education champions and support from external funders momentum are being developed. and collaborators. Importantly, these departments have All four directors recognized that capacity-building in the potential to serve as catalysts to promote scho- HPE was an important component of their work and larship in the field, and to enhance the standard and Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 Page 8 of 9

relevance of medical education. Ultimately the aim is to c) To what extent is the Medical Education strengthen the health work force to promote the quality Department/Unit at your institution involved of care for all. in medical education research? d) To what extent does the Medical Education Department/Unit prepare students for a career Appendix 1: Medical Education Department: as a medical educator? Please give an example. Interview Guide e) To what extent does the Medical Education School: Department/Unit serve as a change agent within your institution (i.e. promotes organizations A. Medical Education Department/Unit Background improvement for the purpose of achieving 1. What is the Medical Education Department/Unit higher degrees of excellence)? Please give an called at your institution? example. 2. In what year was the Medical Education 2. To what extent is the Medical Education Department/Unit established? Department/Unit at your institution involved 3. What are their primary goals of the Medical with grant programs funded by the Medical Education Department/ Unit or Medical Education Education Partnership Initiative (MEPI)? Coordinator at your institution? F. Overarching Evaluation 4. Please describe the process of initiating the 1. Please describe any future plans for the Medical Medical Education Department/Unit at your Education Department/unit at your institution. institution. 2. What factors have prevented or limited a) What individual or individuals pushed the the implementation of a Medical Education process? Department/unit or Medical Education Coordinator b) Why was the development of a medical at your institution? education department/unit deemed necessary? 3. Have there been any specific successes stemming c) What support was needed? from the Medical Education Department/Unit? If B. Staffing so, please describe. 1. Is the Medical Education Department/Unit 4. Is there anything else you would like to share directed by a faculty member? If so, who is this about the Medical Education Department/Unit individual? at your institution? a) Does this individual have advanced training in medical education? If so, please describe. Competing interests 2. How many full-time equivalent personnel are The authors declare that they have no competing interests. assigned to the Medical Education Department/ Unit? Authors’ contributions EKM, ZMT and SCvS made substantial contributions to conception and 3. How is the Medical Education Department/Unit design of the article as well as the drafting the initial manuscript and later staffed? revision thereof. HW, SCC, JG, SSB and LM participated in the design and C. Funding drafting of the manuscript. EKM, ZMT, JG and SCvS conducted the interviews. All authors contributed to the revision of the manuscript, have given approval 1. What are the sources of funding for the Medical of the final version and agree to be accountable for all aspects of the work in Education Department/ Unit? ensuring that questions related to the accuracy or integrity of any part of the D. Position within the Institution work are appropriately investigated and resolved. ’ 1. Within your institutions structure, to whom does Acknowledgements the Medical Education Department/Unit report? The authors acknowledge the United States Government, the President’s 2. How would you describe the status of the Medical Emergency Plan For AIDS Relief (PEPFAR), National Institutes of Health (NIH), Human Resources and Service Administration (HRSA), George Washington Education Department/Unit at your institution? University, Africa Centre for Global Health and Social Transformation (ACHEST) E. Activities and the four schools that participated in this study. The guidance provided by 1. What are the primary activities of the Medical the reviewers during the peer review process towards publication is also gratefully acknowledged. Education Department/Unit at your institution? We further wish to acknowledge the contribution made by Diaa Elgaili a) Does the Medical Education Department/Unit Abubakr to the initial conceptualization of this study. He was the Head of have a relationship with the library at your Department of Mental Health, and Director of the Education Development and Research Center at the Faculty of Medicine University of Gezira, Gezira, institution? If so, please describe. Sudan, but unfortunately passed away in the early stages of the project. b) Does the Medical Education Department/Unit have a relationship with the unit that works Funding/Support Though there was no direct funding for this work, the team of authors came on Instructional Technology (IT support) at together through their work and association with the Medical Education your institution? If so, please describe. Partnership Initiative (MEPI). All the schools involved are recipients of MEPI Kiguli-Malwadde et al. BMC Medical Education (2015) 15:109 Page 9 of 9

funding. MEPI is funded by the Office of the U.S. Global AIDS Coordinator (OGAC), the National Institutes of Health (NIH), and the Health Resources and Service Administration (HRSA).

Author details 1The MEPI Coordinating Centre at the African Centre for Global Health and Social Transformation, Kampala, Uganda. 2MEPI Coordinating Center in the Department of Health Policy at the George Washington University, Washington, DC, USA. 3School of Education and Human Development, University of Colorado, Denver, USA. 4College of Health Sciences, University of Health Sciences, Harare, Zimbabwe. 5Department of Medical Education Development, University of Zambia, Lusaka, Zambia. 6Lane Medical Library, Stanford University, Stanford, USA. 7Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa.

Received: 6 June 2014 Accepted: 19 June 2015

References 1. Mullan F, Frehywot S, Omaswa F, Sewankambo N, Talib Z, Chen C, et al. PEPFAR’s effort to boost health worker education to strengthen health systems. Health Aff (Millwood). 2012;31(7):1561–72. 2. Chen C, Buch E, Wassermann T, Frehywot SMF, Omaswa F, Greysen SR, et al. A survey of Sub-Saharan African medical schools. Hum Resour Health. 2012;10:4. 3. Mullan F, Frehywot S, Omaswa F, Buch E, Chen C, Greysen SR, et al. Medical schools in sub-Saharan Africa. Lancet. 2011;377(9771):1113–21. 4. Davis MH, Karunathilake I, Harden RM. AMEE Education Guide no. 28: The development and role of departments of medical education. Med Teach. 2005;27(8):665–75. 5. Wilkerson L, Doyle L. Developing teachers and developing learners, Chapter 19. In: Dornan TMK, Scherpbier A, Spencer J, editors. Medical education: theory and practice. Edinburgh: Churchill-Livingstone; 2011. 6. Gruppen LD. The Department of Medical Education at the University of Michigan Medical School: A Case Study in Medical Education Research Productivity. Acad Med. 2004;79(10):997–1002. 7. Irby DM, Hodgson CS, Muller JH. Promoting research in medical education at the University of California, San Francisco. School Med Acad Med. 2004;79(10):981–4. 8. Hodges B. Advancing health care education and practice through research: The University of Toronto, Donald R. Wilson Centre Res Educ Acad Med. 2004;79(10):1003–6. 9. Adkoli BV, Sood R. Faculty development and medical education units in India: a survey. Nat Med J India. 2009;22(1):28–32. 10. Al Shawwa AL. The establishment and roles of the Medical Education Department in the faculty of Medicine, King Abdul Aziz University, Jeddah Saudi Arabia. Oman Med J. 2012;27(1):4–9. 11. Van der Vleuten CP, Dolmans DH, de Grave WS, van Luijk SJ, Muijtjens AM, Scherpbier AJ, et al. Education Research at the Faculty of Medicine, University of Maastricht: Fostering the Interrelationship between Professional and Education Practice. Acad Med. 2004;49(10):990–6. 12. University of Michigan. Available from: http://www.med.umich.edu/meded/. 13. Ofoegbu EN, Ozumba BC. Establishment of an office of medical education. Nigeria Med Educ. 2007;41(5):505–26. 14. Monekosso GL. A Brief History of Medical Education in Sub-Saharan Africa. Acad Med. 2014;89:S11–5. 15. Al-Wardy MN. Medical Education Units: History, Functions, and Organization. Sultan Qaboos University Medical Journal. 2008;8(2):149–56. Submit your next manuscript to BioMed Central 16. Cousins G. Researching Learning in Higher Education: an introduction to and take full advantage of: contemporary methods and approaches. New York: Routledge; 2009. 17. Subha R, Sam L. AMEE Guide no. 34: teaching in the clinical environment. • Convenient online submission Med Teach. 2008;30(4):347–64. • Thorough peer review 18. Page MS, Fleetwood J. The double helix of activity and scholarship: building a medical education career with limited resources. Med Ed. 2008;42:34–44. • No space constraints or color ﬁgure charges 19. Frehywot S, Mullan F, Vovides Y, Korhumel K, Chale SB, Infanzon A, et al. • Immediate publication on acceptance Building communities of practice: MEPI creates a commons. Acad Med. 2014;89(8):S45–9. • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution

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